Atrial Fibrillation

More thumping

Step 1: View clinicals

A 61 year old man complains of a "fluttering feeling" in his chest for the last hour. He is mildly anxious, but denies dizziness or faintishness. No other symptoms are present. He has experienced several such episodes over the last 2 months. He was diagnosed with hypertension 10 years ago, but was poorly compliant with his treatment. He does not smoke and only drinks socially. A full blood count and electrolytes are found to be normal.


Step 2: Order all relevant investigations

ECG

The rate is 114 bpm, with an irregular rhythm. The baseline is irregular and p waves are absent.

Chest X-Ray

The x-ray appears normal.

Thyroid profile

TSH: 0.01 mIU/l (very low) Free T3: 8.7 pg/mL (high) Free T4: 12.3 ng/l (high)

Echocardiogram

Left ventricular hypertrophy is noted. Cardiac contractions are irregular, but systolic function is normal with an ejection fraction of 56%. No left atrial thrombi are seen and no regional ventricular wall motion abnormalities are noted.


Step 3: Select appropriate management

Anticoagulation stat
Antibiotics stat
Beta-blockers stat
Electrical cardioversion stat


Score: ā˜…ā˜…ā˜†